Basic Information
| Provider Information | |||||||||
| NPI: | 1902841018 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TPS III OF PA, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HAHNEMANN PRIMARY SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 827794 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191827794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155465000 | ||||||||
| FaxNumber: | 2155466100 | ||||||||
| Practice Location | |||||||||
| Address1: | 231 N BROAD ST | ||||||||
| Address2: | 1ST, FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191071511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155570212 | ||||||||
| FaxNumber: | 2155570508 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 07/28/2016 | ||||||||
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| AuthorizedOfficialLastName: | JAMES | ||||||||
| AuthorizedOfficialFirstName: | WESLEY | ||||||||
| AuthorizedOfficialMiddleName: | O. | ||||||||
| AuthorizedOfficialTitleorPosition: | REGIONAL CFO, TENET | ||||||||
| AuthorizedOfficialTelephone: | 4042655009 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.